Non Small Cell Lung Cancer

Question 1

What is first line for non-squamous non-small cell with no mutations?

Answer 1

Platinum and pemetrexed
followed by maintainence pem

Must give B12 and folate!!

Question 2

What is second line for non-squamous non-small cell lung cancer?

Answer 2

Docetaxel +/- nintedanib

Question 3

What is first line for squamous cell lung cancer with no mutations?

Answer 3

Platinum + gem/vin

Question 4

What is second line for squamous cell with no mutations?

Answer 4

Docetaxel

Question 5

How is immunotherapy used in NSCLC?

Answer 5

PDL1 >50% pembro monotherapy (unless non smoker)

PDL1 < 49% chemoimmuno

Question 6

What is the chemoimmuno regime in PDL1 < 49% non-small cell lung cancer?

Answer 6

chemo + pembro x4

maintainence pembro

Question 7

What is the immuno monotherapy in non small cell with PDL1 >50%?

Answer 7

Pembro - 2 year limit
Atezo - no limit

Question 8

List the common mutations in order of how common they are

Answer 8

1. KRAS 30%
2. EGFR 15%
3. ALK 5%
4. MET exon 14 4%
5. BRAF 2%
6. ret 1%
7. ntrk

Question 9

What is first line KRAS mutation NSCLC?

Answer 9

Carbo/Pem/Pem

Question 10

What is second line KRAS mutation NSCLC?

Answer 10

Sotorasib

Question 11

What is first line treatment for EGFR mutated NSCLC?

Answer 11

Osimertinib

(Gefitinib if poor PS or Afatanib if Osimertinib not an option)

Question 12

What is second line treatment for EGFR mutated NSCLC?

Answer 12

Carbo/Pem